二孔法腹腔镜与开放性精索静脉曲张手术的临床比较

Comparison of the Clinical Outcome: the 2 Ports Laparoscopic Varicocele Ligation and the Open Surgery

目的比较二孔腹腔镜下与开放性精索静脉曲张手术的临床效果。方法自2011年2月~2012年10月,我单位行精索静脉高位结扎术41例,其中二孔法腹腔镜精索静脉高位结扎术23例(二孔腹腔镜组),开放高位精索静脉结扎术18例(开放手术组)。结果二孔腹腔镜组和开放组手术时间分别为20~40分钟、30~50分钟,住院时间分别为2~4天、3~7天,两组比较,差异有统计学意义(P【0.05)。术后两组复发率分别为0%(无复发)和5.56%(1例),术后两组并发症分别为二孔腹腔镜组出现1例局部皮下和阴襄少量积气患者,开放手术组出现睾丸鞘膜积液及阴囊水肿各1例,并发症发生率分别为4.3%和11.1%,两组间术后并发症比较。具有统计学差异(P【0.05)。术后随访3~12个月,二孔腹腔镜组术后血管彩超示无血流反流信号,精液质量改善20例(87%),开放手术组发现2例患者出现血流反流信号,精液质量改善14例(77%)。结论与开放性精索静脉曲张高位结扎手术相比,二孔法腹腔镜精索静脉高位结扎术手术时间短,住院时间短,并发症少,复发率低、术后精液质量改善效果好等优点。

Objective To compare the clinical outcome of two ports laparoscopic varicocele ligation and the open surgery.Methods From February 2011 to October 2012,41 cases of varicocele ligation were performed in our institution,in which there were 23 two ports laparoscopic varicocele ligation cases(two ports laparoscopic group),and 18 open high spermatic vein ligation cases(open surgery group).Results The operation time was 20 to 40 minutes and 30 to 50 minutes in two ports laparoscopic group and open surgery group,respectively.The hospitalization time was 2 to 4 days and 3 to 7 days,in two ports laparoscopic group and open surgery group,respectively.The difference was statistically significant(P < 0.05).Postoperative recurrence rate of the two groups were 0%(no recurrence) and 5.56%(1 case),respectively.The postoperative complications in the two ports laparoscopic group had one case of a small amount of local subcutaneous,and the patients in the open surgery group had 1 case of hydrocele and 1 case of scrotal edema,the complication rate was 4.3% and 11.1%,respectively,and the difference between the two groups was significent(P < 0.05).Patients were followed up for 3 to 12 months,the vascular ultrasound showed no blood reflux signal in the two ports laparoscopic group,the semen quality in 20 cases improved(87%),and vascular ultrasound showed 2 cases of reflux flow signal in the open surgery group,the semen quality in 14 cases improved(77%).Conclusions Comparing to the open varicocele ligation surgery,the two ports laparoscopic varicocele ligation took the advantage of shorter operative time,shorter hospital stay,fewer complications,fewer recurrence rate,and better postoperative semen quality improvement.